Guatemala City is the population center of the country of Guatemala with nearly 25 percent of its citizens living within the city. The country has begun to create a national health care system, but an estimated 40 percent of its people still have no access to health care services. Due to this lack of access and a general distrust of traditional western medicine by the indigenous people, many patients have congenital and chronic illnesses which often go untreated for years. Vanderbilt sends teams of surgeons, nurses, and anesthesiologist/residents/CRNAs for two weeks, twice a year, to provide clinical services at facilities in Guatemala City. Patients are typically screened the day before the surgical week, appropriate patients are scheduled for the week, and the schedule proceeds with patients usually staying over night after their procedure.

Anesthetic concerns include unknown co-existing diseases which the patients might not communicate; restricted availability of standard monitoring or ventilating systems; and limited supplies, which the team transports to Guatemala for each trip. System issues include varied levels of sophistication depending on the facility; the inability to operate on “complicated patients” due to limited post-operative care; and the differing practice philosophy of Vanderbilt health care teams compared to that of local practitioners. Vanderbilt works in conjunction with both the Shalom Foundation and the Guatemalan Pediatric Foundation to coordinate these clinical service trips.